Standard Operating Procedures

Manual For Ambulance Operations

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Standard Operating Procedure

Contents
Introduction and Background ------------------- 29
General Standard Operating Procedures -- 30
Specific Standard Operating Procedures -- 33
Code of Conduct ---------------------------------------- 39
Annexure/SOP1-5-----------------------------------------

43

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Section 1: Standard Operating

Procedures
for
Ambulance
Operations
1.1. Introduction:
This manual provides Standard Operating Procedures (SOPs) for operating
ambulances at the Rural Hospitals (RH) / Block Primary Health Centres
(BPHC) in West Bengal.
Standard Operating Procedures are a set of written instructions that
should be followed in every sphere of activity in order to achieve economy,
efficiency, effectiveness and uniformity. In other words SOPs are prescribed
procedures that tell who will do what, where, when, why and how.
1.2 Background
Accessibility to emergency health services especially emergency obstetric
care is still a major concern in remote areas of West Bengal despite
ambulance services being operated by the Red Cross Society, St. Johns
Ambulance, other NGOs and Private Bodies. Operating ambulance services
in such areas will help to improve accessibility, safety and security of
patients because ambulance services are meant to bridge the gap between
the need for critical care of patients and timely care to be offered by
hospitals / physicians for diagnosis and treatment of ailing patients.
To meet this need for emergency health care Government of West
Bengal decided to set up emergency transportation services by
involving reputed NGOs/CBOs/Trusts, etc to take-up day to day
operational
management
of
ambulance
services.
Accordingly,
133Ambulance Services at the level of Rural Hospitals (RH)/ Block Primary
Health Centres (BPHC)/Primary Health Centres (PHC) managed by
NGOs/CBOs etc under PPP have become operational in eight districts of
West Bengal from March 2005. Encouraged by the initial success of the
scheme, DoHFW has now decided to replicate this scheme in the
remaining Blocks of the eight districts as well as at the Block level in other
districts of the state.

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For successful and efficient running of ambulance services by these

NGOs/CBOs/Trusts, etc it is essential to have and follow Standard
Operating Procedures that will direct all those involved in ambulance
operations to perform and accomplish tasks with a greater degree of
efficiency, economy and uniformity.
SOPs in the case of ambulance operations will be of two types, general and
specific.
General SOPs will detail out the General Attributes and Conduct of
Personnel/NGOs involved in ambulance operations while specific SOPs
will help direct people involved in ambulance operations to respond to and
act upon requests for ambulance services in specific ways.

Section 2 General Standard

Operating Procedures
2.1 General Attributes & Conduct of Personnel Involved
in Ambulance Operations
2.1.1. Respect and Consideration
Ambulance Services personnel will treat all patients with respect and
consideration regardless of their race, color, sex, creed, culture, economic
status and religious beliefs. There will be no discrimination on the basis of
race, sex, sexuality and sexual orientation.
2.1.2. Professional Execution
Both the driver and the attendant will ensure that the vehicle and related
equipments are washed and cleaned once daily and in between
transportation of patients. The driver of the vehicle will check the status of
fuel, oxygen cylinder and other necessary equipment as per the checklist
provided (Annexure/SOP- 1) every morning as well as before leaving for a
call. Both the driver and the attendant will complete all paperwork related
to ambulance operations in between calls and at the end of the day.
The cleaning of vehicle, cleaning of equipment, completion of paperwork,
and continuing maintenance of the vehicle are absolutely necessary for
proper and timely functioning of ambulance services.

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2.1.3. Attendance
Both the driver and the attendant will be available for ambulance duty at
any point of time to perform the duty. It is the responsibility of the
operating partner to ensure that regular attendance and punctuality is
maintained at all points of time.
2.1.4. Uniform
Standard uniform code will be dark gray shirts and trousers. Both the
driver and the attendant will wear uniforms as specified above while on
duty to promote professionalism and facilitate identification as ambulance
operations staff.
2.1.5. Physical Fitness
The Driver and the attendant will remain physically and mentally fit and
sound so as to be able to perform their duties at all times.
2.1.6. Patient Disposition
Patients should be transported to the hospital as per the guidelines
specified in the Scheme
2.1.7. Communication Protocols
Proper communication protocols need to be maintained with the callers
and patient party.
Guidelines/Protocols:
Simple, direct, professional and courteous language will be used at all
times.
When an ambulance is dispatched on the basis of a call the dispatcher will
ensure that the ambulance is responding to the correct address.
Contact with the dispatch (ambulance and driver) will be maintained at all
times.
Some commonly used Ambulance Operation terms are:
Available

: ambulance is available to respond to a call.

On call

: ambulance is picking up or transporting a patient

Out of Service

: ambulance is not available to respond

Received
Responding
Status

: ambulance staff has received the information.

: ambulance is en route to a call
: Find out the availability of ambulance

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Welfare Check
staff

: To check the physical welfare of the ambulance

On Scene

: Ambulance has arrived at call location.

Transporting
hospital. Must be followed

: Ambulance is transporting the patient to a

by hospital name.
Arriving at Hospital
name)

: Ambulance has arrived at the hospital (use

2.1.8 Mobile Phone

The NGO/CBO/Trust shall provide a mobile phone to the Driver of the
Ambulance for enabling the Driver to establish timely communication
link with the RH/BPHC.

2.2 Infection Control By Ambulance Personnel

i. Use all protective gears for handling patients at all times
ii. When the possibility of exposure to blood or other body fluid exists,
gloves are recommended. If hands accidentally become contaminated with
blood, they should be washed thoroughly as soon as possible.
iii. When there is a risk of eye or mouth contamination (for example, the
patient is vomiting bloody material or there is arterial bleeding), protective
eyewear and masks are recommended.
iv. Masks should be worn by the ambulance staff or patient for those
infectious agents transmitted by airborne diseases like Tuberculosis,
Chicken Pox, Measles and the like
v. Equipment should be thoroughly cleaned after each use.
vi. All significant exposures shall be reported to the Superintendent/
BMOH/MOIC immediately so that necessary action can be taken.

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Significant exposure is defined as the following:

i. Any puncture of the skin by a needle or other sharp object that has had
contact with patients blood or body fluids or with fluids infused into the
patient.
ii. Blood spattered onto mucous membranes (e.g. mouth or eyes).
iii. Contamination of open skin (cuts, abrasions, blisters, open dermatitis)
with blood, saliva, amniotic fluid, etc..
2.3. Patient Care Reports/ Documentation
Documentation is one of the most important aspects of completing an
ambulance call. Both the call receiver as well as the driver of the
ambulance must maintain and complete call reports. Patient Care Reports
are frequently referred to as Call Reports. The documentation norm will be

a. Complete report on each patient for any call (Annexure/SOP- 2)

b. All call reports to be recorded in duplicate as the call occurs and the
duplicate copy kept in office file.
c. All calls to be registered in the Log Book after the completion of the
call (Annexure/SOP- 3)

Section 3: Specific Standard

Operating Procedures
The primary function of an ambulance is emergency transportation of
obstetric care, accident and other emergency health cases from the
villages/places of residence to the RH/BPHCs or to the SubDivisional/District/tertiary hospital or to a nearest private hospital. Request
for ambulance services will therefore come to the RH/BPHC through
telephone or in the form of a personal caller for transporting accident or
obstetric care and other emergency health cases (termed hereunder as
normal emergency cases) as per guidelines mentioned below.
3.1A. Request For Ambulance
Transporting Emergency Cases

Services

Over

Telephone

For

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3.1A1.
An
employee
of
RH/BPHC
authorized
by
the
Superintendent/BMOH/MOIC will receive a phone call requesting for
ambulance services.
3.1A.2 Details of request will be noted in the Request for Ambulance / Call
Record form (Annexure 2) in duplicate. Full address and clear direction for
location of the patient supported by important landmarks will also be noted
down. The employee of RH/BPHC will in turn inform about user charges
and mode of payment to the caller.
3.1A.3 The filled-in form should be signed by Superintendent/BMOH or
Medical Officer on duty
or any other person authorized by
Superintendent/BMOH/MOIC before dispatch of the ambulance.
3.1A.4 Thereafter, the original of the form is to be handed over to the
driver of the ambulance immediately. The copy of the form should be kept
in office file.
3.1A5. The concerned employee will immediately try to establish contact
with the driver of the ambulance and pass on the necessary information. If
contact cannot be established with the driver of the ambulance within 30
minutes, the same should be informed to the telephone caller so that the
patient party can make alternate transportation arrangements.
3.1A6. In case, the patient is to be transported to any center other than the
RH/BPHC , the concerned employee will intimate and obtain prior
permission for the same from the Superintendent/BMOH/MOIC and then
pass on the necessary information to such center

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3.1B Request For Ambulance Services In Person (By Patients

Relatives or Neighbour) For Transporting Emergency Cases
3.1B.1.Details of request will be noted in the Request for Ambulance form
(Annexure 2) in duplicate. Full address and clear direction for location of
the patient supported by important landmarks will also be noted down. The
employee of Superintendent/BPHC will in turn inform about user charges
and mode of payment to the caller.
3.1B.2 The filled-in form should be signed by Superintendent/BMOH or
Medical Officer on duty or any other person authorized by
Superintendent/BMOH/MOIC before dispatch of the ambulance.
3.1B.3.Thereafter the original of the form is to be handed over to the driver
of the ambulance immediately. The copy of the form should be kept in
office file.
3.1B.4.In case the Ambulance is out on duty, the concerned employee of
Superintendent/BPHC will inform the same to the person and request
him/her to wait up to a maximum of half an hour
3.1B.5.The concerned employee will immediately try to establish contact
with the driver of the ambulance in the Drivers mobile phone and pass on
the necessary information. If contact cannot be established with the
ambulance within 30 minutes, the same should be informed to the personal
caller so that
the patient party can make alternate transportation
arrangements
3.1B.6. In case of ambulance being available the concerned employee of
RH/BPHC will inform about its availability and details of user charges and
mode of payment to the personal caller, requesting for ambulance.
3.1B.7. In case, the patient is to be transported to any center other than
the RH/BPHC, the concerned employee will intimate and obtain prior
permission for the same from the Superintendent/BMOH/MOIC and then
pass on the necessary information to such center.

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3.2. Pick-up and transportation of patient

3.2A. If the ambulance is available at the RH/BPHC at the time of
receipt of call/personal caller
3.2A.1. Before movement, the driver will check the status of fuel, oxygen
cylinder and other necessary equipment as per the Check List provided to
him (Annexure/SOP- 1)
3.2A.2. The driver / attendant will take with him the Request for
Ambulance and blank Money Receipt form in duplicate (Money
Receipt form: Annexure/SOP- 4)
3.2A.3. On reaching the pick-up point, the driver will produce Request for
Ambulance form and get the same signed with the time of arrival for pickup mentioned at the column provided, by the patients relative.
3.2A.4. The driver / attendant will also tell the patients family members to
take with them the prescription of the Doctor and other important reports.
3.2A.5. The driver and attendant will ensure safe shifting of the patient to
the ambulance on a stretcher, wherever required, with the help of the
accompanying attendant and family members of the patient.
3.2A.6. Only two persons from the patients family will be allowed to
accompany the patient in the ambulance.
3.2A.7. The driver/attendant will ensure use of oxygen cylinder/other life
saving equipment by the patient, if required.

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3.2B. In case the ambulance is not available at RH/BPHC during

time of telephone call /personal caller
3.2B.1. In case the ambulance is not posted at the RH/ BPHC at the time of
receipt of request for ambulance, the driver, on receiving a call from the
RH/BPHC , needs to go to the place of the patient directly from another
location.
3.2B.2. He will use a blank Request for Ambulance form available with
him and arrange to fill in all relevant details in the form
3.2B.3. Thereafter, the procedures from 3.2A.1. to 3.2A.7. as mentioned
above will be followed
3.2B.4. The Driver shall obtain a post facto approval in the Call Record
from the Superintendent/BMOH/MOIC.

3.3. Drop-in of the patient at RH/BPHC or other referral

point/hospital
3.3.1. The driver / attendant will take the relatives accompanying the
patient to the Medical Officer of RH/BPHC Referral Hospital on duty for
next course of action
3.3.2. The driver / attendant will then get the Request for Ambulance
form signed along with mention of Time of release in the column
provided by the family member of the patient, collect user charges and
hand over the properly filled money receipt.
3.3.3. The driver will fill the Log Book (Annexure/SOP- 3) kept in the
Ambulance in the custody of the driver and be produced to the
Superintendent/ BMOH/MOIC whenever asked for.
3.3.4. The driver will inform of his arrival to the receiver of requests for
ambulance at the RH/BPHC.

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3.4. Transportation of Accident Emergency Patients

3.4A. Request For Ambulance Services
Transporting Accident Emergency Cases

Over

Telephone

For

3.4A.1. An employee of RH/BPHC authorized by Superintendent/BMOH

will receive a phone call requesting ambulance services for transporting
accident cases.
3.4A.2
Details of request will be noted in the Call Record form
(Annexure/SOP- 2) in duplicate. Clear directions for locations of the
accident victims supported by landmarks will also be noted down.
3.4A.3. The filled-in form should be signed by the RH/BMOH/MOIC on
duty before dispatch of the Ambulance.
3.4A.4. Thereafter, the original of the form is to be handed over to the
driver of the Ambulance immediately. A copy of the form should be kept in
the office file.
3.4A.5. In case the patient is to be transported to any centre other than
the RH/BPHC, the concerned employee will pass on the necessary
information to such centre.
3.4A.6. In case the Ambulance is out on duty, at the time of the telephone
call, the same should be intimated to the telephone caller with a request to
make an alternative arrangement in case of an extreme emergency.
However, the caller would also be requested to call back after 10 minutes
in case no alternative arrangement could be made by the caller for
transportation of the patient.. In between, contact would be established
with the driver through phone and depending on the status, necessary
actions would be taken.

3.4B. Request For Ambulance Services By A Personal Caller For

Transporting Accident Emergency Cases
3.4B.1. Details of request will be noted in the Call Record form
(Annexure/SOP- 2) in duplicate and the same should be signed by the
personal caller. Clear directions for locations of the accident victims
supported by landmarks will also be noted down.

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3.4B.2.
The
filled-in
form
should
be
signed
by
the
Superintendent/BMOH/MOIC on duty before dispatch of the Ambulance.
3.4B.3. Thereafter, the original of the form is to be handed over to the
driver of the Ambulance immediately. A copy of the form should be kept in
the office file.
3.4B.4. In case, the patient/s are to be transported to any center other
than the RH/BPHC, the concerned employee will pass on the necessary
information to such center.
3.4B.5. In case the Ambulance is out on duty, the same will be intimated to
the personal caller. However, contact would be established with the driver
through phone and depending on the status, necessary actions would be
taken.

3.5. Pick-up and transportation of injured patient/s

3.5.A. If the ambulance is posted at the RH/BPHC at the time of

receipt of telephone call/personal call
3.5.A.1. Before movement, the driver will check the status of fuel, oxygen
cylinder and other necessary equipment as per the Check List provided to
him (check list details: Annexure/SOP 1).
3.5.A.2. The driver
(Annexure/SOP-2)

will

take

with

him

the

Call

Record

form.

3.5.A.3. On reaching the pick-up point, the driver will ensure safe shifting
of the patient/s to the ambulance on a stretcher, wherever required, with
the help of the accompanying attendant.
3.5.A.4. The driver/attendant will ensure use of oxygen cylinder/other
lifesaving equipment by the patients if required.

3.6. Pick-up and transportation of patient/s

Residence to Private Hospitals/Nursing Home

from

3.6.1 The Driver shall obtain a post facto approval in the Call Record
Form from the Superintendent/BMOH who would approve such
movement after being satisfied about the same.

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3.7 Transportation of patient/s to the Bordering States

3.7.1 If the patients, residing in the blocks closer to the bordering states,
prefer to be transported to some specific hospitals/nursing homes of those
states for treatment, such transportations will be allowed for the benefit of
the patients with the prior intimation to the Superintendent/BMOH / MOIC.

Section 4: Code of Conduct

4.1. Roles, Responsibilities &
Operating NGOs/CBO/Trust/etc:

Obligations

Of

The

4.1.1. Ambulance Operations

a. The NGOs/CBO/Trust/etc. partner will exclusively use the ambulance for
carrying the emergency and referral patients within the district and from
the villages to the RH/BPHC and to the Sub- Divisional/District/Tertiary and
nearest private sector hospital.
b. The driver of the ambulance will obtain written instruction for each
movement of the ambulance from the Superintendent/BMOH or any other
employees authorized by the Superintendent/BMOH/MOIC in this regard
c. The NGOs/CBO/Trust/etc partner will be responsible for providing
ambulance services to patients who are in need of the same on a round the
clock basis.
d. If required by the condition of the patient, the ambulance will pick up
patients from their place of residence.

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e. In case a patient does not wish to use the services of a RH/BPHC but
wishes to go directly to a higher end facility or a nearest private hospital,
the NGOs/CBO/Trust/etc. can transport such patients to their desired
destination in consultation with the RH/BMOH/MOIC to determine that
there is no higher priority emergency case awaiting transportation at the
RH/BPHC .If during an emergency, the patients are picked up from their
residences and transported directly to the Private Hospitals/Nursing
Homes, the Superintendent/BMOH/MOIC shall post facto approve such
movements in the Call Record after being satisfied about the same.
f. The NGOs/CBO/Trust/etc will ensure that there are no lapses or
negligence in providing such services to needy patients.
g. The NGOs/CBO/Trust/etc will ensure that the vehicle downtime is not
more than one day a month
h. The NGOs/CBO/Trust/etc will abide by the Standard Operating
Procedures for Ambulance Operations provided to them at the time of
handing over of the vehicles.
4.1.2. Allowances
The NGOs/CBO/Trust/etc will recruit and bear the allowances of the
ambulance driver as well as the attendant.
The NGOs/CBO/Trust/etc will also bear all clerical expenses incurred in
relation to the ambulance
operations and reporting requirements

4.1.3 Parking
The NGOs/CBO/Trust/etc will park the ambulance in the RH/BPHC
compound. In case of parking space not available in the RH/BPHC, the
NGOs/CBO/Trust/etc can park the vehicle at a place arranged by it near
the
RH/BPHC
after
obtaining
permission
from
the
Superintendent/BMOH/MOIC. The NGOs/CBO/Trust/etc. can if required
construct a temporary shed within the BPHC / PHC campus for parking of
the vehicle.
4.1.4 Movement Register/Log Book
The NGOs/CBO/Trust/etc will maintain a movement register/logbook,
(Annexure/SOP-3) which will be kept and regularly updated by the
driver of the ambulance, indicating therein the distance covered and
user charges realized from the patient or his/her representative. The

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logbook
will
be
regularly
Superintendent/BMOH/MOIC.

checked

and

signed

by

the

4.1.5 User Charges

a. The NGOs/CBO/Trust/etc will be entitled to collect and retain user
charges as per the rates fixed by the DHFWS. These charges can be used
to meet expenditures related to operation, maintenance and management
of the ambulance. Money Receipt (Annexure/SOP-4) must be issued
against receipt of user charges.
b. If two patients are transported at the same time to the referral centers,
the total user charges would be equally apportioned amongst the patients.
c. NGOs/CBO/Trust/etc will not offer free services to any patient.

4.1.6 Operation Costs

The NGOs/CBO/Trust/etc will bear all operation costs and expenses for
plying the vehicle including the cost of fuel, lubricants, spare parts and
repairing, regular servicing as well as the AMC.
4.1.7 Reports
The NGOs/CBO/Trust/etc will be responsible for preparing and submitting
the necessary ambulance utilization reports (Annexure/SOP 5) in
prescribed Monthly Report Format and other relevant paper work to the
Superintendent/BMOH/MOIC and the BHFWS within the stipulated time.
Copy of Monthly Report needs to be submitted to the CMOH of the District
and Special Secretary, Department of Health & Family Welfare, Swasthya
Bhawan, 4th floor, Wing-B, GN-29, Sec-V, Bidhannagar, Kolkata 700091.The
Superintendent/BMOH/MOIC will provide information relating to point
nos. 12-A, 12-B, 13-A and 13-B of the Monthly Report. The
NGOs/CBOs/Trusts/etc will be required to ensure that all information are
properly filled in the Monthly Report and the report is sent to all concerned
so as to reach by 7th of every month.
4.1.8 Handover
The NGOs/CBO/Trust/etc will handover the ambulance to DHFWS in
good condition subject to normal wear and tear in case of termination
of the agreement or on expiry of the agreement without claiming any
ownership or right whatsoever.

4.2. Code Of Conduct Of The Person Receiving The Call

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Will be polite

Will listen attentively

Will be sympathetic

Will record all details as per format

Will give feedback and act as per feedback

Will not initiate dialogue not relevant to ambulance operations

Will give correct information regarding availability of ambulances

Will give correct information on user charges

Will be cordial with the driver and attendant

Will not use aggressive and abusive language

Will not shout or scold

Will note down full details and not take incomplete information

4.3. Code Of Conduct Of The Driver/Attendant

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Will be cleanly dressed in uniform

Will be polite

Will be sympathetic

Will be punctual and on time

Will complete paperwork

Will check all operational details of the ambulance every morning and
before leaving for an assignment as per checklist (Annexure 1)

At all times will drive the ambulance within permissible speed limits. At
10kms to 20 kms per hour in busy/crowded areas and 30 kms per hour
in less crowded areas/intersections

Will not use the hooter indiscriminately. Will use the hooter only while
transporting patients.

Will not chew or smoke in front of patients and during transportation

and inside the ambulance when the ambulance is not running.

Will not consume alcohol during duty hours or should not have
consumed alcohol 4 hours prior to departure

Will not shout or use abusive language

Will not charge extra money from the relatives of the patients

Will not harass patients

- 20 -

Checklist
Annexur/SOP-1
Driving and Vehicle Operations
Before driving any ambulance a driver must have the following
documentation:
Current, valid Driving License
Clean Driving Record from the Department of Motor Vehicles (No
Record of Reckless Driving, not more than two moving violations in the
past one year).

Vehicle
Vehicle documents required:

Certificate of Registration,

Certificate of Road Worthiness/Fitness,

Tax Receipt
Insurance Certificate
Pollution Certificate

Operational Checklist

Fuel
Brake Oil
Gear Oil
Coolant
Life saving equipment
Stretcher in place
Vehicle is clean
Hooter is working
Money Receipt
Blank Ambulance Request Form
Battery for the Mobile Phone is fully charged.

- 21 -

- 22 -

Annexure/SOP- 2
Request for Ambulance Form/Call Record
Date:

Time:

Patient Name:
Caller Name:

Tel/Person/Referred by B/PHC:

Relationship with Patient:

Age of Patient:

Sex of Patient:

Address:
Place of Pick Up:
(Including clear directions)
Important Landmarks:
Destination:
Complaint:

Referral Doctor:

Signature of Call Receiver/Driver:

Authorization by Superintendent/BMOH or his/her representative:

- 23 -

Annexure/SOP- 3
Sample of Ambulance Logbook/Ambulance Movement Register
Date Sta
rt
kms
.

Pati
ent
s
Na
me

Plac
e of
Pick
Up

Tim
e
\In

Place
of
Drop

Tim
e
Out

Time of
Return
to
RH/BP
HC

End
kms.

Signature
of the
driver of
the
ambulanc
e

Checke
d&
signed
by
Superin
tendent/
BMOH

- 24 -

- 25 -

Annexure/SOP-4

Money Receipt
Name of Patient:
Sex:

Age:

Date:

Time:

Start kms:

Pick Up (kms):

Drop (kms):
Total Distance Travelled (kms.):
Rate Per Kilometre:
Amount Collected in Rupees:
Signature of recipient:
Signature of Patient/Patient Party:

- 26 -

Annexure/SOP- 5
MONTHLY REPORT OF THE NGOS FOR THE AMBULANCE SCHEME UNDER PPP
1. Name of the RH/BPHC/PHC: _________________ 2. District ______________
3. Name of the NGO: _________________________
5. Reporting Month: _________________________

4. Vehicle No. _________________

6. Date of Submission ___________

7. TOTAL NUMBER OF PATIENTS TRANSPORTED DURING

THE MONTH
7-A. Type of patients
transported
Accident emergency
cases
Delivery related
cases
Child related cases
Other Emergency
cases
Others (specify)
Total Patients

7-B. Details of transportation

Referred from
RH/BPHC/PHC
Residence to RH/
BPHC/PHC
Residence to other govt.
hospitals
Residence to private
hospitals

7-C. Category of
patients
transported
BPL
NON-BPL

Others (specify)
Total Patients

Total Patients

8-A) Opening Kilometer on the first day of the month

8-B) Closing kilometer on the last day of the month
8-C) Total kilometer travelled during the month
9-A) Number of days the ambulance did not carry any patient
9-B) Reasons:
10-A) Number of times the ambulance used for some other purposes:
10-B) Reasons:
11. Problems encountered / Important case studies/ General comments:

Information under 12-A, 12-B, 13-A and 13-B to be provided by the

Superintendent/BMOH
12-A) Total number of patients referred from the RH/BPHC/PHC
(OPD+Em+IPD) during the month
12-B) Number patients availed this (PPP) ambulance out of the total referrals
from the RH/BPHC/PHC during the month
13-A) Total number of beneficiaries under the Referral Transport Scheme from
the RH/BPHC/PHC during the month

- 27 13-B) Number of the beneficiaries availed this (PPP) ambulance out of the total
beneficiaries under the Referral Transport Scheme from the RH/BPHC/PHC
during this month

Full Signature and Designation of the Reporting Person

of the NGO with seal and date

Abbreviations:

BPHC

Block Primary Health Centre

BHFWS

Block Health and Family Welfare Samiti

BMOH

Block Medical Officer of Health

BPL

Below Poverty Line

CBO

Community Based Organisation

CMOH

Chief Medical Officer of Health

DHFWS

District Health and Family Welfare Samiti

DoHFW

Department of Health and Family welfare

GoWB

Government of West Bengal

MOIC

Medical Officer In Charge

NGO

Non-Governmental Organisation

ONGOs

Operating NGOs

PHC

Primary Health Centre

POL

Petrol, Oil, Lubricant

PPP

Public Private Partnership

Pvt.

Private

RH

Rural Hospital

SOP

spo